Experiences with Holmium Laser Enucleation of the Prostate, HoLEP, Laser Surgery

In this clinical study, “Thulium Laser Versus Holmium Laser Transurethral Enucleation of the Prostate: 18-Month Follow-up Data of a Single Center”
( by FengboZhang and QiangShao published in Urology, April 2012),

The authors said that out of 133 patients “No urethral or bladder neck stricture were found in either group.”

So it does seem that Dr. Das 5% chance of scar formation is an overestimate. 2% is probably a better number.

The study’s objective is
“To compare the clinical outcomes between thulium laser transurethral enucleation of the prostate (ThuLEP) (70 W) and holmium laser transurethral enucleation of the prostate (HoLEP) (90 W) in a prospective randomized trial with 18 months of follow-up. Both ThuLEP and HoLEP effectively relieve the obstructive symptoms due to benign prostatic hyperplasia (BPH).”

It described HoLEP as follows:
“The physical characters of the pulsed holmium:YAG laser include a “scar-free” feature on the prostatic surface with precise incision and dissection simultaneous with coagulation of small and medium-size vessels. Hence, as the incision reaches the surgical capsule, the transitional prostatic lobes will burst from this plane to make the enucleation procedure easier. ”

Oops! I neglected urethral stricture. When urethra stricture (2.1%) is added to BNC (1-2%), the scar formation rate goes up to 3-4% so Dr. Das’s 5% is not high after all.

See for exapme

“RESULTS: A total of 1216 HoLEP procedures were operated between March 1998 and October 2013 with a mean prostate volume of 94.8
52.7cc. Catheter time and hospital stay were 1.4
1.9 and 1.3
1.6 days, respectively. After a mean follow-up of 7.3 years (1- 14 years), 52 (4.3%) patients needed reoperation for recurrent LUTS; 13 (1.07%) for recurrent adenoma, 14 (1.15%) for BNC and 25 (2.05%) for de novo urethral stricture. In multivariate regression, smaller prostate size and history of previous prostate surgery predicted recurrence of adenoma. BNC was significantly associated with smaller glands while longer operative time and postoperative catheterization were significantly associated with urethral stricture (Table 1). A Kaplan-Meier curve demonstrates freedom from post- HoLEP reoperation to be 96.9% at 5- years and 95.1% at 10- years (Figure1).”

J Endourol. 2015 Jul;29(7):797-804. doi: 10.1089/end.2015.0060. Epub 2015 Apr 2.
Reoperation After Holmium Laser Enucleation of the Prostate for Management of Benign Prostatic Hyperplasia: Assessment of Risk Factors with Time to Event Analysis.

Elkoushy MA, Elshal AM, Elhilali

My guess, LUTS=Lower urinary track symptoms?

Found this excellent YouTube video for doing Kegel excercise and it is the best that I have come across.
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It is designed for patients with their prostate removed and are suffering both STRESS and URGE incontinence by a nurse who specializes in helping those patients. Expnantion is very clear.

The steps are the same as what Buster told me. However, it went much further. It seems it should be useful even for people who had regained their continence. Doing the excercises suggested in the video could offer more control of their continence.

I remember there is a reader who had regained his continence except when he was giving a talk. I hope he can watch the video and see if the exercise can cure his stress incontinence.

Yes, I like this. I have also used additional exercises to Break the boredom and to add some additional techniques to work the pelvic floor muscles.

I hadn't been on this site for a few weeks, but, in catching up today, I had the same experience as Blayned with respect to the catheter put in after surgery until used until the next morning. It did not bother me at all except for 2-5 seconds when it was taken out and I definitely remember when it was removed. Other than that, the surgery and the post-surgery experience was great. I had my surgery in Dec., 2014 with Dr. Lingeman and I'm very happy I traveled to see him. I did have to go back five months later due to a bladder neck contracture, but, a simple 10-15 minute procedure fixed things. I was fortunate to have a wonderful, caring urologist in Michigan who recommended I go to see Dr. Lingeman as I was retaining way too much fluid. It was my fault as I had ignored his pleas for me to go have HOLEP for several years. I was up to 800cc of retainage in my bladder. Not smart on my part. Does anyone know if Dr. Lingeman is till practicing?

Hello Buster,

I am glad u like it. I like Huges’s explanation when one is coughing, sitting down or lifting a heavy object, the pressure inside the bladder increases. When the bladder pressure increases to the level that is greater than resisting pressure of the external sphincter, urine leaks out.

Thus, it makes good sense to practice Kegel under those conditions (coughing, sitting down or lifting).

I believe one of his excercises by laying down then pull up the upper body while doing Kegel also increases pressure on the bladder. Thus, it is the same idea.

I now follow his Kegel routine.

Congratulations on ur successful holep!

It seems that u didn’t have incontinence after Holep which is great. Dr. Das told me that 5% of his patients have either bladder neck contracture or urethral stricture and my own research confirmed the 5%.

For the 10-15 min fix, just curious if Dr. L used HoLEP to clear out the scar at the bladderneck? Some papers said that bladder neck contracture could return. Jus t wondering if u see any evidence of that.

Perhaps one could call Doing Kegel under stressful situations dynamic Kegel as oppose to static Kegel.

I like doing them while I am standing. Another method I like is to lay flat with my feet flat and then raise my butt up. While in that position I do 20 quick contractions. I then repeate that move 5 times.

Yes he was still practicing as of January of this year.

Good idea. U have the same idea as Hughes: putting more pressure on the bladder while doing Kegel.

It also teaches you to use a quick squeeze for those times you need a quick response.

I am grateful that this thread have people like u, Phillip and Blayneb sharing ur experience and helping other readers. Without all ur helps, I probably would not have started doing Kegel. I feel good that I am reasonably well prepared for holep.

Thank u all gain!